Influenza vaccination in individuals with egg allergy
- John M Kelso, MD
John M Kelso, MD
- Section Editor – Anaphylaxis
- Division of Allergy, Asthma, and Immunology
- Scripps Clinic, San Diego, CA
- Julie Wang, MD
Julie Wang, MD
- Associate Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
The majority of the intramuscular inactivated influenza vaccines (IIVs) and the intranasal live-attenuated influenza vaccine (LAIV) are cultured on fluid from chicken embryos. As a result, there is a small amount of egg protein in these vaccines. Thus, there is a theoretical risk of inducing an allergic reaction when administering the influenza vaccine to an individual with egg allergy. However, many of these same patients are also at higher risk of an adverse outcome due to influenza infection (eg, age <2 years, history of asthma) and would therefore benefit from vaccination.
This topic reviews the risks and benefits of administration of the influenza vaccine in patients with egg allergy. Other issues related to egg allergy (including prevalence) and allergic reactions to vaccines are discussed separately. (See "Egg allergy: Clinical features and diagnosis" and "Allergic reactions to vaccines".)
The measles, mumps, and rubella (MMR) vaccine is not contraindicated in patients with egg allergy. This is discussed in detail separately. (See "Allergic reactions to vaccines", section on 'Measles, mumps, and rubella' and "Egg allergy: Management", section on 'Egg-containing vaccines and lipid emulsions'.)
RISKS ASSOCIATED WITH INFLUENZA INFECTION
Both seasonal and pandemic influenza infection can lead to severe infection and death, particularly in certain high-risk groups. Seasonal influenza results in higher mortality rates among patients with certain chronic medical conditions (eg, asthma), pregnant women, and those at the extremes of age. (See "Clinical manifestations of seasonal influenza in adults", section on 'Complications of influenza' and "Seasonal influenza in children: Clinical features and diagnosis", section on 'Complications' and "Influenza and pregnancy", section on 'Clinical course in pregnancy'.)
Influenza vaccination is recommended for all individuals six months of age and older and is particularly important in those at increased risk of complications. (See "Seasonal influenza vaccination in adults" and "Seasonal influenza in children: Prevention with vaccines", section on 'Target groups'.)
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- RISKS ASSOCIATED WITH INFLUENZA INFECTION
- RISK OF ANAPHYLAXIS TO VACCINE
- Fatal anaphylaxis
- VACCINE EGG PROTEIN CONTENT
- SAFETY OF VACCINES IN PATIENTS WITH EGG ALLERGY
- ALTERNATIVE METHODS OF VACCINE PRODUCTION
- APPROACH TO EVALUATION AND VACCINE ADMINISTRATION
- Risk assessment
- Vaccine choice
- Our approach
- SUMMARY AND RECOMMENDATIONS